Precision Physical Distancing for COVID-19: An Important Tool in Unlocking the Lockdown

In response to the COVID-19 pandemic, in addition to the more routine public health measures, many countries have implemented "lockdowns"-closing borders, restricting international travel, and placing severe limitations on individual movement and group gatherings. While lockdowns may be an important tool to limit transmission, they come at a potentially great cost with regard to economic impact, mental health consequences, and increased morbidity and mortality from non-COVID-19 diseases. Furthermore, implementation of the required draconian measures may be difficult in some settings because of logistical, economic, and sociocultural impediments, especially in many low- and middle-income countries. Governments and health authorities must chart a course on how to "unlock" or control transmission where lockdowns are not feasible. "Precision physical distancing"-distancing tailored and optimized to specific physical, social, cultural, political, and economic contexts and to specific groups and settings-is proposed and discussed here as an important tool in the control of COVID-19. It has the advantages of being low cost, adaptable to diverse sociocultural and economic settings through community ownership and local action, and more easily monitored and potentially enforced than less precise measures. Precision physical distancing can be one important component of a sustainable long-term solution that is proportionate to the risk yet does not have a disproportionate impact on society and the economy, allowing a partial return to normal activities, with the community as an essential partner.